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BMJ 2012; 345 doi: (Published 08 August 2012) Cite this as: BMJ 2012;345:e5315

Combination of drugs prolongs survival for women with metastatic breast cancer

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Compared with a regimen of giving anastrozole alone and exchanging it for fulvestrant if disease progresses, both drugs given together from the start improved progression-free survival by a month and a half and overall survival by six months in women with metastatic breast cancer.

Participants in this phase III trial were 694 postmenopausal women with hormone receptor positive metastatic breast cancer (oestrogen or progesterone receptor positive, or both). Anastrozole inhibits the synthesis of oestrogen and is taken orally each day, whereas fulvestrant acts at the oestrogen receptor and is given in monthly injections. None of the women had metastases in the central nervous system or had previously been treated for breast cancer, other than with tamoxifen.

In women who received the single drugs, median survival without disease progression was 13.5 months, compared with 15.0 months in women allocated combination treatment. For overall survival—a prespecified secondary outcome—these figures were 41.3 months and 47.7 months, respectively.

Three deaths that may have been associated with treatment occurred in the combination drug group, compared with none in the single drug arm. In the two groups, 11 and four patients, respectively, stopped treatment early because of toxic effects. Although severe adverse events were more common with combination treatment (46/346 v 38/332 with single drug treatment), the difference wasn’t significant.

VTE is most common in patients with cancer of the brain and pancreas


One in five deaths from venous thromboembolism (VTE) is in people with cancer. A systematic review of cohort studies quantified the risks associated with eight common types of cancer. Forty six papers that reported on 38 studies were eligible for inclusion. Participants in 31 studies were classified as high risk, because they had metastases or were receiving certain treatments, whereas participants in seven studies were considered to …

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